Recommended regimens for Helicobacter pylori
| Susceptibility-based, for patients with no drug allergies |
| Clarithromycin triple therapy (For infections susceptible to clarithromycin) All of the following twice daily for 14 days: Clarithromycin 500 mg Amoxicillin 1 g A proton pump inhibitor a |
| Metronidazole triple therapy |
| (For infections susceptible to metronidazole) All of the following twice daily for 14 days: Tinidazole 500 mg or metronidazole 500 mg Amoxicillin 1 g A proton pump inhibitor a |
| Fluoroquinolone triple therapy (For infections susceptible to fluoroquinolones) All of the following for 14 days: A fluoroquinolone (eg, levofloxacin 500 mg once daily) Amoxicillin 1 g twice a day A proton pump inhibitor twice a daya |
| Susceptibility-based, for patients allergic to penicillin |
| Bazzoli’s triple therapy (For infections susceptible to clarithromycin and metronidazole) All of the following twice daily for 14 days: Clarithromycin 500 mg Tinidazole 500 mg or metronidazole 500 mg A proton pump inhibitor a |
| Bismuth quadruple therapy (For infections resistant to clarithromycin or metronidazole) All of the following for 14 days: Bismuth subcitrate or subsalicylate 2 tablets 4 times daily with meals and at bedtime Tetracycline hydrochloride 500 mg 4 times daily with meals and at bedtime Metronidazole or tinidazole 500 mg 3 times daily with meals A proton pump inhibitor twice a day a |
These therapies are expected to achieve > 90% (often > 95%) cure rates with susceptible infections and adherent patients
↵a Preferred proton pump inhibitors are omeprazole 40 mg, lansoprazole 45 or 60 mg, rabeprazole 20 mg, or esomeprazole 20 mg; pantoprazole is not recommended as 40 mg is approximately equivalent to 9 mg omeprazole.